Caesarean sections-delivering the baby via an abdominal operation-are at an all-time high, and a growing number of doctors and mothers-to-be elect for C-sections as a convenient alternative to birth. However, new evidence shows that C-section babies are almost three times as likely to die in early infancy.

In late September of this year, researchers in the US dropped a bombshell onto the cosy world of obstetrics. After analyzing the records of nearly six million births, they advised that mothers should think twice before choosing a caesarean section (CS) over a natural birth.

Quite simply, an artificial surgical delivery could be putting the life of the newborn at risk. What the stark American statistics revealed was that caesarean babies are almost three times more likely to die within their first month of life than naturally delivered babies (Birth, 2006; 33: 175).

And yet, caesarean births ('C-sections' in medico-speak) have never been more popular. For an increasing number of mothers-to-be, the ready availability of CS has meant that the trauma of giving birth can be leapfrogged. The old Biblical curse of having to endure a painful labour is exorcisable-birth can be as simple as having an appendix removed.

Take this passage from a popular American book on pregnancy: "With a scheduled caesarean section, you and your doctor have agreed to a time at which you will enter the hospital in a fairly calm and leisurely fashion, and he or she will extract your baby through a small slit at the top of your pubic hair. There are a lot of reasons to schedule a C-section, [including] to maintain the vaginal tone of a teenager." (Iovine V. The Girlfriends' Guide to Pregnancy. Pocket Books, 1995).

What is a caesarean? For centuries, the classical CS operation has involved a long surgical incision made either vertically or horizontally across the centre of the abdomen, cutting through to the womb below. However, the operation is fraught with complications-not least of which is huge blood loss-and is now rarely performed for this reason. However, the modern CS entails a much smaller incision (a mere four to five inches across) low down on the abdomen, just below the top of the pubic hair-the resulting scar thus conveniently invisible even under a bikini.

The term 'caesarean' is popularly thought to be named after the Roman leader Julius Caesar who was allegedly born that way. However, doctors now think that story is unlikely, as the operation would almost certainly have killed his mother (given the medicine of the day)-and yet, historical records show that she was still alive after he reached adulthood.

A more plausible derivation is from the term lex caesarea, a Roman law passed during Caesar's reign decreeing that, if a mother was dying during childbirth, the baby could be surgically removed to save its life.
In the US, 29.1 per cent of all births are now delivered by CS, according to 2004 statistics. And the British figure is not far behind at 21.6 per cent. Of these, almost half (8.9 per cent) are 'elective'-in other words, chosen by the mother, not by the doctor because of a medical emergency (BMJ, 2004; 328: 1399). Why so many? After all, the UK does not have the same financial or litigious pressures as has the US.

The answer appears to be that some women (anecdotally, the British upper classes) consider normal births too traumatic, inconvenient, distasteful and disfiguring to put up with-an attitude memorably summarized as 'too posh to push'.

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